The studies in this Project concern infants and young children at very high risk for developmental retardation and psychopathology because of their exposure to risk factors during gestation and postnatally. Specifically, we will focus on the interaction between the neurobiological insult of gestational drug exposure and growing up in high risk environments. The use of cocaine by pregnant women (often in combination with alcohol and other drugs) has increased rapidly in the last five years and more fetuses are being exposed. Many reports now document the neurophysiological manifestations of cocaine exposure in the immediate neonatal period, but there is little information about the neuropsychological development of these children after the first one to two months and no studies of attention regulation and rigorously defined aspects of development in preschool aged children. The neuro- pharmacological effects of cocaine in animals and adults, as well as clinical reports describing attentional impairments exhibited by preschool children proposed to cocaine prenatally, suggest that infants exposed to cocaine in utero may be at continuing and various risk for central nervous system dysfunction. The studies in this Project are based on a rigorous, longitudinal investigation from birth to 60 months of children exposed to cocaine in utero. The study focuses on the long-term effects on the regulation of attention and states of arousal, cognitive development, and adaptive behavior. Infants and young children prenatally exposed to cocaine are compared to children whose mothers are cocaine- free and both groups are seen at 3, 6, 12, 18, and 24 months and every 6 months from 30 to 60 months. At these times, repeated measures are done of four variables (arousal regulatory capacities, regulation of attentional states, general developmental competency and adaptive behavior). Additionally, because of the contributions of maternal behavior to children's regulation of attention, mental interactions with the child and examined at each time point. This study has important applications for understanding how impairments in attention and arousal regulation impact cognitive performance, adaptive behavior, and social interaction in the preschool aged child. The emphasis of this Project Area on neurobiological vulnerability and environmental interaction in developmental disorders is closely related to the other Projects in this Program Project. This Project also makes an important contribution to an area of high national concern, the neurobiological and environmental factors involved in the development of children exposed to drugs.
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